Tacrolimus-based immunosuppression seems safe and effective in liver and kidney transplantation. To assess the safety and efficacy of tacrolimus (TAC)-based immunosuppression after cardiac ...transplantation as well as the relative impact of tacrolimus on immunosuppression-related side effects such as hypertension and hyperlipidemia, we conducted a prospective, randomized, open-label, multicenter study of otherwise identical tacrolimus- and cyclosporine-based immunosuppressive regimens in adult patients undergoing cardiac transplantation.
Eighty-five adult patients (pts) at six United States cardiac transplant centers, undergoing their first cardiac transplant procedure, were prospectively randomized to receive either TAC-based (
n = 39) or cyclosporine (CYA)-based (
n = 46) immunosuppression. All pts received a triple-drug protocol with 15 pts (18%) receiving peri-operative OKT3 to delay TAC/CYA due to pre-transplant renal dysfunction. Endomyocardial biopsies were performed at Weeks 1, 2, 3, 4, 6, 8, 10, 12, 24, and 52. The study duration was 12 months.
Patients were mostly male (87%) Caucasian (90%) with a mean age of 54 years and primary diagnoses of coronary artery disease (55%) and idiopathic dilated cardiomyopathy (41%). There were no significant demographic differences between groups. Patient and allograft survival were not different in the two groups. The probability and overall incidence of each grade of rejection, whether treated or not, and the types of treatment required did not differ between the groups. At baseline and through 12 months of follow-up, chemistry and hematology values were similar between the groups except serum cholesterol was higher in the CYA group at 3, 6, and 12 months (239 vs 205 mg/dL, 246 vs 191 mg/dL, 212 vs 186 mg/dL, respectively,
p < 0.001). Likewise, LDL-cholesterol, HDL-cholesterol and triglycerides were significantly higher in the CYA group. More CYA patients received therapy for hypercholesterolemia (71% vs 41% at 12 months,
p = 0.01). There were no significant differences in renal function, hyperglycemia, hypomagnesemia, or hyperkalemia during the first 12 months. More CYA patients developed new-onset hypertension requiring pharmacologic treatment (71% vs 48%,
p = 0.05). The incidence of infection was the same for the two groups (2.6 episodes/pt/12 month follow-up).
Tacrolimus-based immunosuppression seems effective for rejection prophylaxis during the first year after cardiac transplantation and is associated with less hypertension and hyperlipidemia and no difference in renal function, hyperglycemia or infection incidence when compared to cyclosporine-based immunosuppression.
The recent history of the Soufriere Hills volcano, Montserrat, Lesser Antilles volcanic arc, is deduced using data obtained from a submarine core collected in 2002. The core contains concentrations ...of ash and several tephra layers, which are identified by the abundance of glass shards, dense and poorly vesiculated particles, and scoria. The tephra layers have been dated using micropalaeontology and stable isotope stratigraphy. Tephra layers in a marine sediment core off the coast of Montserrat record the volcanic history of South Soufriere Hills-Soufriere Hills volcano back to 250 ka. Eight layers are composed of dense juvenile ash related to dome eruptions, five of which can be directly correlated to dated domes or related pyroclastic flow sequences on land. Six layers are composed of pumiceous glassy ash and relate to significant explosive eruptions. A marker sequence of basalt tephra layers is dated at 124-147 ka and is correlated with construction of the South Soufriere Hills basaltic stratocone. Pelagic sediments between the main tephra layers have low abundances of volcanogenic components (<15%) and suggest long periods (c. 104 years) of dormancy or low activity.
Bioclastic flow deposits offshore from the Soufrière Hills volcano on Montserrat in the Lesser Antilles were deposited by the largest volume sediment flows near this active volcano in the last 26 ...kyr. The volume of these deposits exceeds that of the largest historic volcanic dome collapse in the world, which occurred on Montserrat in 2003. These flows were most probably generated by a large submarine slope failure of the carbonate shelf comprising the south-west flank of Antigua or the east flank of Redonda; adjacent islands that are not volcanically active. The bioclastic flow deposits are relatively coarse-grained and either ungraded or poorly graded, and were deposited by non-cohesive debris flow and high density turbidity currents. The bioclastic deposit often comprises multiple sub-units that cannot be correlated between core sites; some located just 2 km apart. Multiple sub-units in the bioclastic deposit result from either flow reflection, stacking of multiple debris flow lobes, and/or multi-stage collapse of the initial landslide. This study provides unusually precise constraints on the age of this mass flow event that occurred at ca 14 ka. Few large submarine landslides have been well dated, but the slope failures that have been dated are commonly associated with periods of rapid sea-level change.
•We present a global biogeography and mtCO1 phylogeny for all atlantid morphospecies.•An updated biogeography for all morphospecies is constructed from museum collections.•Phylogeny of 437 new and 52 ...published sequences revealed 33 clades, 10 that are new.•Some new clades have unique morphological characters and may represent new species.•New clades have distinct distributions, suggesting narrow environmental tolerances.
The atlantid heteropods are regularly encountered, but rarely studied marine planktonic gastropods. Relying on a small (<14 mm), delicate aragonite shell and living in the upper ocean means that, in common with pteropods, atlantids are likely to be affected by imminent ocean changes. Variable shell morphology and widespread distributions indicate that the family is more diverse than the 23 currently known species. Uncovering this diversity is fundamental to determining the distribution of atlantids and to understanding their environmental tolerances. Here we present phylogenetic analyses of all described species of the family Atlantidae using 437 new and 52 previously published cytochrome c oxidase subunit 1 mitochondrial DNA (mtCO1) sequences. Specimens and published sequences were gathered from 32 Atlantic Ocean stations, 14 Indian Ocean stations and 21 Pacific Ocean stations between 35°N and 43°S. DNA barcoding and Automatic Barcode Gap Discovery (ABGD) proved to be valuable tools for the identification of described atlantid species, and also revealed ten additional distinct clades, suggesting that the diversity within this family has been underestimated. Only two of these clades displayed obvious morphological characteristics, demonstrating that much of the newly discovered diversity is hidden from morphology-based identification techniques. Investigation of six large atlantid collections demonstrated that 61% of previously described (morpho) species have a circumglobal distribution. Of the remaining 39%, two species were restricted to the Atlantic Ocean, five occurred in the Indian and Pacific oceans, one species was only found in the northeast Pacific Ocean, and one occurred only in the Southern Subtropical Convergence Zone. Molecular analysis showed that seven of the species with wide distributions were comprised of two or more clades that occupied distinct oceanographic regions. These distributions may suggest narrower environmental tolerances than the described morphospecies. Results provide an updated biogeography and mtCO1 reference dataset of the Atlantidae that may be used to identify atlantid species and provide a first step in understanding their evolutionary history and accurate distribution, encouraging the inclusion of this family in future plankton research.
Aneurysms of the visceral arteries are rare but potentially life-threatening anomalies.1 Aneurysms of the splenic and renal arteries account for most cases in published series. They are usually ...asymptomatic, but rupture can result in death.2 An - eurysms of the renal artery occur with an estimated prevalence of 0.6% to 1.0% angiographically and are bilateral in about 10% of cases.3 With the widespread use of abdominal imaging modalities, detection of asymptomatic aneurysms of the renal artery is more common. No consensus exists regarding the optimal management of this finding. The two most common elective interventions are resection of the aneurysm with reconstruction of the renal artery, and endovascular embolization.3
The Hatay Graben is one of three easternmost basins in the Mediterranean that preserve sediments that span the Miocene–Pliocene boundary, including gypsums from the Messinian Salinity Crisis (MSC). ...Here we integrate existing data and present new sedimentological and micropalaeontological data to investigate the palaeoenvironments of late Miocene to early Pliocene deposits and place this important area into a regional stratigraphic framework. Six sections are described along a ~W–E transect illustrating the key features of this time period. Late Miocene (Pre-MSC) sediments are characterised by open marine marls with a benthic foraminiferal fauna suggestive of water depths of 100–200m or less. Primary lower gypsum deposits are determined to be absent from the graben as sedimentological and strontium isotopes are characteristic of the Resedimented Lower Gypsums. The intervening Messinian erosion surface is preserved near the basin margins as an unconformity but appears to be a correlative conformity in the basin depocentre. No Upper Gypsums or ‘Lago Mare’ facies have been identified but available data do tentatively suggest a return to marine conditions in the basin prior to the Zanclean boundary. Sediments stratigraphically overlying the Messinian gypsums and marls are coarse-grained sandstones from coastal and Gilbert-type delta depositional environments. The Hatay Graben is not only strikingly similar to Messinian basins on nearby Cyprus but also to the overall model for the MSC, demonstrating the remarkable consistency of palaeoenvironments found in marginal basins across the region at this time. This research also raises questions as to the timing of the Mediterranean reflooding and the significance of the widespread mega-breccias of the resedimented gypsum deposits.
Heart failure is the most common cause of hospitalization in the United States. Just as the prevalence of heart failure has increased, the number of diseases identified that result in the heart ...failure syndrome has escalated. Certain cardiomyopathies that have previously been regarded
as very rare are being recognized with increasing frequency, because of improved imaging techniques and an increased understanding of the pathophysiologic mechanisms that result in these diseases. Improved echocardiographic techniques and methods such as spectral Doppler and 3D image rendering,
along with the use of advanced diagnostic tools such as cardiac CT angiography and cardiac magnetic resonance imaging are now common. These advanced imaging methods have led to an increased appreciation of the frequency of diseases such as isolated left ventricular noncompaction and cardiac
amyloidosis. Left ventricular noncompaction, once thought to occur in roughly one in one million patients, may actually be seen in fewer than one in 1000 patients. Cardiac amyloidosis, in the senile form, may exist in 80% of 80-year-old patients, although the incidence of clinical symptoms
is less. As the genetic alterations that contribute to these diseases are further elucidated, improved diagnosis and a better understanding of the prognosis of these uncommon cardiomyopathies will follow.
Benthic foraminiferal faunas (> 63 μm) and stable isotopes from the last 15 kyr were studied in BENGAL programme (high-resolution temporal and spatial study of the BENthic biology and Geochemistry of ...a north-eastern Atlantic abyssal Locality) kasten core 13078#16 from the Porcupine Abyssal Plain, NE Atlantic (48°49.91 N, 16°29.94 W, water depth 4844 m). Changes occurred in the accumulation rates, species composition, diversity, and stable isotopes during the last 15 kyr. Today, the area is strongly influenced by seasonal inputs of phytodetritus following the spring blooms in surface water primary productivity. Variations in the relative abundance of the two most abundant species,
Epistominella exigua and
Alabaminella weddellensis, which today show significant increases in abundance with the presence of phytodetritus on the sea-floor, are interpreted as resulting from changes in the seasonality of productivity. Seasonal productivity was higher during the Holocene than during the last deglaciation and Younger Dryas, probably coinciding with the retreat of the polar front to higher latitudes. This hypothesis is consistent with simultaneous decreases in the percentage of the polar planktic foraminifera
Neogloboquadrina pachyderma (s), and increases in the percentage of
Globigerina bulloides, a warmer water planktic foraminifera indicative of phytoplankton blooms and enhanced productivity. The relative abundance of the ‘phytodetritus species’ (
E. exigua and
A. weddellensis) covary between 14.7 and 8.1 kyr, but not between 7.8 and 1.2 kyr. Major decreases in the numbers per gram and accumulation rates of planktic and benthic foraminifera occurred at ∼
12–8.5 kyr and at ∼
4 kyr which correspond to decreases in the % sediment coarse fraction and published data on inorganic carbon contents suggesting that dissolution may have increased at these times. Relationships between benthic foraminiferal faunas and benthic stable isotope records suggest no simple relationship between faunal abundances and test isotope chemistry. For example, the abundances of phytodetritus species do not show strong correlations with either the
δ
13C values of
E. exigua or the Δ
δ
13C
E. exigua − P. wuellerstorfi
record, which have previously been suggested as indicative of seasonality of productivity.
► Benthic foraminifera associated with CO2 vents in the Gulf of California. ► Living calcareous benthic foraminifera in low pH conditions. ► Evidence of post-mortem test dissolution.
Extensive CO2 ...vents have been discovered in the Wagner Basin, northern Gulf of California, where they create large areas with lowered seawater pH. Such areas are suitable for investigations of long-term biological effects of ocean acidification and effects of CO2 leakage from subsea carbon capture storage. Here, we show responses of benthic foraminifera to seawater pH gradients at 74–207m water depth. Living (rose Bengal stained) benthic foraminifera included Nonionella basispinata, Epistominella bradyana and Bulimina marginata. Studies on foraminifera at CO2 vents in the Mediterranean and off Papua New Guinea have shown dramatic long-term effects of acidified seawater. We found living calcareous benthic foraminifera in low pH conditions in the northern Gulf of California, although there was an impoverished species assemblage and evidence of post-mortem test dissolution.
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